Eficiência clínica de fios de polidioxanona no tratamento da flacidez tissular abdominal pós-parto: relato de caso / Clinical efficiency of polydioxanone threads in the treatment of postpartum abdominal tissue flaccidity: case report

Este estudo relata um caso de flacidez abdominal após 3 gestações no qual foi utilizada a técnica de fios de polidioxanona (PDO) lisos e espiculados, técnica ainda não descrita na literatura paratratarestaqueixa.Apacientefoiacompanhadapor90dias,ehouvemelhoradaabertura da prega umbilical, do tônus da pele, de densidade dérmica e da flacidez tissular após 60 dias. Neste período, a paciente declarou estar totalmente satisfeita e foiestabelecidaaaltadotratamento.Comestepresenterelatodecasopodemosconcluirquea terapia combinada de fios de PDO parafusos e fios de PDO espiculados (Sculpt®) apresentam resultados muito expressivos em relação a qualidade da pele promovendo melhora visível na flacidez tissular

Thisstudyreportsacaseofabdominalflaccidityafterthreepregnancies,inwhichthetechnique ofsmoothandspiculatedpolydioxanonethreadswasused,atechniquenotyetdescribedinthe literature to treat this complaint. The patient was followed up for 90 days, but there was an improvement in the opening of the umbilical fold, skin tone, increase in dermal density and especially a reduction in tissue flaccidity in 60 days. During this period, the patient declared thatshewascompletelysatisfied,anddischargefromtreatmentwasestablished.Withthiscase report, we can conclude that the combined therapy of PDO threads screws and PDO threads spiculated (Sculpt®) presentvery expressive results about the quality of the skin, promoting a visible improvement in tissue flaccidity

Análise do potencial do reparo ósseo através da reconstrução de ressecções segmentares por meio da associação de scaffolds de Polidioxanona ou malha de titânio e rhBMP-2: estudo in vivo / Bone potential analysis through segmental resection reconstruction using Polydioxanone or Titanium Mesh scaffolds and rhBMP-2: in vivo study

O objetivo deste trabalho foi analisar o potencial bioativo de um "scaffold" de Polidioxanona (PDO) com associação da rhBMP-2, nas reconstruções após simulação de ressecção óssea em fêmures de ratos. Para tanto, 24 ratos, machos, adultos, com 6 meses de idade, foram submetidos a ressecção e reconstrução dos fêmures bilateralmente. Inicialmente foi realizada a estabilização com fixação de placas e parafusos de titânio do sistema 1.5mm e em seguida a confecção de um "gap" de 2mm. A reconstrução foi realizada com rhBMP-2 (Infuse) carreada em esponja de colágeno (3,25 µg), tendo uma malha de titânio, para o grupo Titânio (n=24 fêmures) (grupo controle), atuando como um arcabouço. E para o grupo PDO (n=24 fêmures) (grupo teste), a reconstrução foi realizada também com a rhBMP-2 carreada em uma esponja de colágeno (3,25 µg), envolvido por um "scaffold" de PDO. Desses animais, 16 (2 por tempo) receberam em seu dorso, no plano subcutâneo, um fragmento do mesmo material testado em seu fêmur, para análise de biocompatibilidade, que foram removidos sob anestesia local, junto de fragmento do tecido subcutâneo adjacente, aos 3, 5, 7 e 10 dias para análise. Os animais foram submetidos à eutanásia (n=6 por grupo) nos períodos de 14 e 60 dias após a cirurgia de reconstrução tiveram seus órgãos de metabolização (cérebro, rim, fígado e músculo) removidos para análise anatomopatológica e seus fêmures também foram removidos, reduzidos, radiografados para análise da densitometria radiográfica posteriormente os fêmures passaram por descalcificação e em seguida todas as peças foram submetidas ao processamento para obtenção de lâminas com cortes de 5 µm de espessura, para avaliação histológica, com avaliação da área óssea neoformada e perfil inflamatório e para análise imunohistoquimica através das proteínas Runx2, OPG, RANKL, OCN e BMP2. Todos os dados quantitativos foram submetidos ao teste ANOVA-2 fatores e quando p< 0,05, o pós-teste Tukey foi realizado. Os resultados da densitometria radiográfica demonstraram maior densidade para o grupo PDO, especialmente no período de 14 dias (p< 0,05). Na análise histológica observou-se reparo mais favorável para o grupo PDO, especialmente aos 60 dias quando comparado ao Titânio, com diferença estatística significativa (p = 0.002) bem como menor infiltrado inflamatório e maior número de vasos sanguíneos aos 14 dias. Com relação as imunomarcações, BMP-2 não apresentou marcações para Titânio e dados expressivos para PDO, com diferença significativamente estatística aos 60 dias (p< 0.05). OPG e RANKL mostraram maior marcação para titânio, principalmente aos 60 dias (p< 0.05). Já Runx2 e OCN apresentaram resultados superiores para PDO aos 14 dias, entretanto, aos 60 dias titânio demonstrou maior expressão. A análise de biocompatibilidade mostrou maior processo inflamatório para o grupo titânio. Os órgãos de metabolização apresentaram aspectos de higidez dentro da normalidade para ambos grupos. Os resultados deste trabalho demonstram um padrão reparacional mais favorável à associação do "Scaffold" de PDO com a rhBMP-2, quando comparado a reconstrução com malha de titânio(AU)

The objective of this work was to analyze the bioactive potential of a Polydioxanone (PDO) scaffold with rhBMP-2 association, in reconstructions after simulating bone resection in rat femurs. Therefore, 24 male, adult rats, aged 6 months, underwent resection and reconstruction of the femurs bilaterally. Initially, stabilization was performed with fixation of titanium plates and screws of the 1.5mm system and then a 2mm gap was created. The reconstruction was performed with rhBMP-2 (Infuse) loaded in a collagen sponge (3.25 µg), with a titanium mesh, for the Titanium group (n=24 femurs) (control group), acting as a scaffold. And for the PDO group (n=24 femurs) (test group), the reconstruction was also performed with rhBMP-2 carried in a collagen sponge (3.25 µg), surrounded by a PDO scaffold. Of these animals, 16 (2 per time) received on their back, in the subcutaneous plane, a fragment of the same material tested in their femur, for biocompatibility analysis, which was removed under local anesthesia, together with a fragment of the adjacent subcutaneous tissue, at 3, 5, 7 and 10 days for analysis. The animals were euthanized (n=6 per group) in the periods of 14 and 60 days after the reconstruction surgery, had their metabolizing organs (brain, kidney, liver, and muscle) removed for anatomopathological analysis and their femurs were also removed, reduced, radiographed for analysis of radiographic densitometry later the femurs underwent decalcification and then all the pieces were submitted to processing to obtain 5 µm thick slices for histological evaluation, with the evaluation of the newly formed bone area and inflammatory profile and for immunohistochemical analysis through Runx2, OPG, RANKL, OCN, and BMP2 proteins. All quantitative data were submitted to the 2-way ANOVA test and when p< 0.05, the Tukey post-test was performed. The results of radiographic densitometry showed higher density for the PDO group, especially in the 14-day period (p< 0.05). In the histological analysis, a more favorable repair was observed for the PDO group, especially at 60 days when compared to Titanium, with a statistically significant difference (p = 0.002), as well as a lower inflammatory, infiltrate and a greater number of blood vessels at 14 days. Regarding immunostaining, BMP-2 did not show staining for Titanium and expressive data for PDO, with a statistically significant difference at 60 days (p< 0.05). OPG and RANKL showed higher staining for titanium, mainly at 60 days (p< 0.05). On the other hand, Runx2 and OCN showed superior results for PDO at 14 days, however, at 60 days titanium showed greater expression. The biocompatibility analysis showed a greater inflammatory process for the titanium group. The metabolizing organs presented aspects of health within the normal range for both groups. The results of this work demonstrate a more favorable repair pattern for the association of the PDO scaffold with rhBMP-2, when compared to reconstruction with titanium mesh(AU)

Polydioxanone as Buried Suture in Facial Trauma - A Prospective Study.

Irrespective of cause of injury, facial scars are always considered as a stigma causing both mental and social disgrace to the victim. The principle aim of any suturing is to produce aesthetically pleasing scar. Besides surgical skills, the choice of suture material also plays a very important role in getting a good scar. Though suture material used for suturing is mostly Nylon everywhere, it’s the buried sutures which obliterate the dead space and reduce wound tension which make the real difference in the appearance of scar. Sutures of different types are today available & the operating surgeon uses the best suture material for the patient in a given circumstance based on his personal experience, scientific observations, & manufacturer’s advice.1 METHODSThis is a prospective study conducted in the department of plastic surgery at Christian Medical College, Ludhiana from May 2012 to April 2013. The study included all the patients of facial trauma registered during that period of one year. Demographic profile was noted along with the cause of trauma. A well-informed consent was taken. In our study skin approximation was done by either 5-0 or 6-0 Nylon suture. Buried suture used in all was Polydioxanone (PDS) 5-0. Skin sutures were removed on 5th POD. Beusang Clinical Scar assessment scale2 was used in the study to assess scar appearance. Patients were followed every month for 5 months after removal of skin sutures. The parameters noted included, colour, contour, matte/shine, and texture of scar. Photographic record of the patients was maintained. Statistical analysis was done using McNemar test. RESULTSOut of the 40 patients in our study, road traffic accidents constituted 85 percent of facial trauma, rest included fall on floor. M:F ratio was 3:1. With Polydioxanone as buried suture, 35 patients (87.5%) had normal texture, 30 patients (75%) had Matte appearance of the scar, 20 patients (50%) had no distortion of scar, 25 patients (62.5%) had perfect match of colour with hypertrophic scar noticed in 4 patients (0.1%). CONCLUSIONSPolydioxanone as buried suture gave aesthetically pleasing scar which improved in appearance during the follow up periods. There was significant statistical improvement in scar appearance starting from 5th day of suture removal to assessment at 5 months. No discharge from the wound site was noted in any of the patients. Hypertrophic scars noticed were later treated with steroid injection

Fabrication and evaluation of biomimetic biodegradable tissue-engineered annulus fibrosus scaffold / 中国组织工程研究

BACKGROUND: It is still difficult to construct tissue-engineered anulus fibrosus scaffolds which have bionic structure, suitable biodegradability and good biocompatibility. OBJECTIVE: To fabricate bionic biodegradable scaffolds with polycaprolactone (PCL) and polydioxanone (PDS) and evaluate the feasibility as a tissue-engineered annulus fibrosus scaffold. METHODS: Five groups of scaffolds at different PCL/PDS proportions were prepared by melt spinning technique: PCL, PCL/PDS70/30, PCL/PDS50/50, PCL/PDS30/70, and PDS groups. Scanning electron microscopy was used to observe the structure and measure the fiber diameter and pore size of these prepared scaffolds. The mechanical properties and contact angle of the scaffolds were measured. The in vitro and in vivo biodegradation of the scaffolds were observation by in vitro simulation and subcutaneous implantation. The expression of inflammatory factors interleukin-1β and tumor necrosis factor-α in the biodegraded tissues was detected. Human Wharton’s jelly mesenchymal stem cells were cultured for 7 days. Cell viability and proliferation was determined by live/dead cell staining. This study was approved by the Medical Ethics Committee of Tianjin Hospital, China on March 2, 2016. RESULTS AND CONCLUSION: Scanning electron microscopy results showed that the thickness of the scaffold fibers was uniform and the angle between fibers was 60°. The mechanical properties analysis showed that the tensile and compressive modulus of the PDS group was the lowest, which did not meet the mechanical requirements of the anulus fibrosus; the tensile and compressive modulus in the PCL group was the highest, and those in the PCL/PDS70/30 and PCL/PDS50/50 group were moderate. Hydrophilicity test showed that higher PDS proportion led to better hydrophilicity. Biodegradation test showed that the biodegradation of pure PDS and PCL/PDS30/70 was too fast, that of PCL was too slow, and that of PCL/PDS70/30 and PCL/PDS50/50 was appropriate. Analysis of inflammatory response around the biodegraded tissue showed that higher proportion of PCL in the scaffold resulted in more severe inflammatory response. CCK-8 and live/dead cell staining showed that human Wharton’s jelly mesenchymal stem cells had good proliferative activity and high survival rate in the PCL/PDS70/30, PCL/PDS50/50, and PCL/PDS30/70 groups. These results suggest that scaffolds in the PCL/PDS70/30 and PCL/PDS50/50 groups can simulate the structure of natural annulus fibrosus, have appropriate biodegradability, excellent mechanical properties and good biocompatibility, which make it a suitable candidate for tissue-engineered annulus fibrosus scaffold.

Feasibility of a polydioxanone plate as an adjuvant material in rhinoplasty in Asians

BACKGROUND: Nasal framework-supporting procedures such as septal extension grafts, derotation grafts, and columellar strut grafts are usually required in rhinoplasty in Asian patients because the skin envelope is tight, but the nasal framework is small and weak. Autologous materials are preferred, but they have some limitations related to the amount that can be harvested and the frequency of use. Therefore, synthetic materials have been used to overcome these limitations. METHODS: A total of 114 patients who received a polydioxanone (PDS) plate as an adjuvant material in rhinoplasty from September 2016 to August 2017 were retrospectively investigated. The PDS plate was used as to support the weak framework and to correct the contour of the alar cartilages. The PDS plate was used for reinforcement of columellar struts and septal L-struts, alar cartilage push-down grafts, fixation of septal extension grafts, and correction of alar contour deformities RESULTS: Primary and secondary rhinoplasty was performed in 103 and 11 patients, respectively. Clinically, no significant inflammation occurred, but decreased projection of the tip was observed in seven patients and relapse of a short nose was noted in five patients. CONCLUSIONS: PDS plates have been used in the United States and Europe for more than 10 years to provide a scaffold for the nasal framework. These plates can provide reinforcement to columellar struts, L-struts, and septal extension grafts. In addition, they can assist in deformity correction. Therefore, PDS plates can be considered a good adjuvant material for Asian patients with weak and small nasal cartilage.

Experimental Investigation on the Tissue Response Induced by Face-Lifting Mesh Suspension Thread in Rats

BACKGROUND: Face-lifting procedures are often performed to hide the effects of aging. Thread-lifting, a minimally invasive technique for the correction of facial aging, has become increasingly popular, and various materials for the procedure have been developed. OBJECTIVE: This study compared tissue responses to two types of threading sutures placed under rat skin: polypropylene (PP) monofilament mesh suspension thread (a novel face-lifting material) and polydioxanone (PDO) barbed thread. METHODS: Eight rats each were assigned to the PP monofilament mesh suspension, PDO barbed thread, and control groups. Tissue reactions were evaluated 28 days after subcutaneous loading of the materials. RESULTS: Significant increases in tensile strength and the mean area occupied by collagen fibers were evident in skin loaded with PDO barbed thread and PP monofilament mesh suspension thread compared to control skin (p<0.05). Compared to sites loaded with PDO barbed thread, those loaded with PP monofilament mesh suspension thread showed a significant increase in the number of collagen fibers and a lower grade of inflammation (p<0.05). CONCLUSION: PP monofilament mesh suspension thread has skin-rejuvenating effects comparable to those of PDO barbed thread, but induces a less severe inflammatory response. This indicates that it is a safe and effective material for use in thread-lifting procedures on aging skin.

Evidencia clínica y microscópica de la degradación de hilos de dermosustentación de polidioxanona en presencia de ácido hialurónico: reporte de caso / Microscopic and clinical evidence of the degradation of polydioxanone lifting threads in the presence of hyaluronic acid: a case report

Se expone el caso de una paciente remitida por complicaciones posteriores a la implantación superficial en el tercio medio facial de hilos de polidioxanona espiculados. Presentaba edema, equimosis, palpación superficial del hilo y plicación dérmica. Para el tratamiento planteamos un novedoso protocolo de degradación clínica de hilos de polidioxanona, empleando ácido hialurónico inyectándolo en el área de su implantación. Se infiltró ácido hialurónico no reticulado en el trayecto a lo largo del recorrido del hilo. El seguimiento a los siete, 21 y 45 días evidenció disminución del edema, de los pliegues e irregularidades dérmicas por la tracción del hilo y atenuación de rítides secundarias. Una muestra del hilo en ácido hialurónico fue observado en campana de flujo laminar evidenciándose degradación a las 72 horas. Administrar ácido hialurónico fue efectivo para inducir la biodegradación clínica del hilo. La hipótesis derivada sugiere que el ácido hialurónico no reticulado es un poderoso catalizador de la degradación hidrolítica de la polidioxanona.

We present the case of a female patient with complications from superficial implantation of polydioxanone spiculated threads in the facial middle third. The manifestations were edema, ecchymosis, superficial palpation of the thread and skin plication. For the treatment we propose a novel protocol of clinical degradation of polydioxanone threads, using hyaluronic acid injecting it into the implantation area of the polydioxanone threads. Non-cross linked hyaluronic acid was infiltrated along the path of the thread. The follow-up at seven, 21 and 45 days showed decreased edema, folds and skin irregularities due to wire traction and attenuation of secondary rhytides. A sample of the thread in hyaluronic acid was observed in a laminar flow campaign evidencing degradation at 72 hours. Administering hyaluronic acid was effective in inducing clinical biodegradation of the thread suggesting that non-crosslinked hyaluronic acid is a powerful catalyst for the hydrolytic degradation of polydioxanone.

Differences between polydioxanone and poliglactin in intestinal anastomoses - a comparative study of intestinal anastomoses / Diferenças entre polidioxanona e poliglactina em anastomoses intestinais - estudo comparativo de anastomoses intestinais

ABSTRACT Introduction: Intestinal anastomosis is a surgical practice constantly realized by surgeons worldwide. When the option is to perform manual anastomosis, which is still widely used for its low cost, the question arises as to the best material to be applied. Objective: To compare polydioxanone and polyglactin threads for healing and tensile strength in intestinal anastomosis in rats. Method: We used 25 rats Wistar; after anesthesia, in groups A and B (10 rats each), laparotomy was performed, transection of the ileum at 5 and 10 cm proximally to the ileocecal valve; in group A, anastomosis was performed with 4 separate extra mucosal sutures with polidioxanone; in group B, anastomosis was performed with polyglactin; in group C (5 rats), laparotomy and manipulation of the ileum were performed. After 21 days, the animals were anesthetized and submitted to euthanasia. The specimens were sent for histopathological study and tensile strength analysis. Statistical analysis was performed using the Turkey and Student's t tests, with a significance of p < 0.05. Results: The results showed that in the tensile strength analysis, there were no significant differences between them. The histological analysis showed significant differences between the cicatrization pattern, where polydioxanone caused less fibrosis than polyglactin. Conclusion: Polydioxanone caused less fibrosis than polyglactin in intestinal anastomoses of rats.

RESUMO Introdução: Anastomose intestinal é uma prática cirúrgica constantemente realizada pelos cirurgiões em todo o mundo. Quando a opção é a anastomose manual - um procedimento ainda amplamente empregado, graças a seu baixo custo - coloca-se o problema de saber qual é o melhor material a ser aplicado. Objetivo: Comparar fios de polidioxanona e poliglactina quanto à cicatrização e resistência à tração em anastomoses intestinais em ratos. Método: Utilizamos 25 ratos Wistar; depois da anestesia, foi realizada laparotomia nos grupos A e B (10 ratos cada), com transecção do íleo a 5 e 10 centímetros proximalmente à válvula ileocecal; no grupo A, a anastomose foi realizada com 4 suturas de mucosa separadas com uso de polidioxanona; no grupo B, a anastomose foi realizada com poliglactina; no grupo C (5 ratos), foi realizada apenas a laparotomia e manipulação do íleo. Transcorridos 21 dias, os ratos foram anestesiados e submetidos à eutanásia. Os espécimes foram enviados para estudo histopatológico e análise de resistência à tração. A análise estatística foi efetuada com a aplicação dos testes de Tukey e de t de Student, com significância de p < 0,05. Resultados: Os resultados demonstraram que, na análise de resistência à tração, não foram observadas diferenças significativas entre os materiais. A análise histológica revelou diferenças significativas entre padrões de cicatrização, em que polidioxanona causou menos fibrose versus poliglactina. Conclusão: Polidioxanona causou menos fibrose versus poliglactina em anastomoses intestinais realizadas em ratos.

Continuous absorbable suture versus interrupted permanent suture in the treatment of diastasis of the rectus abdominis muscle / Sutura contínua com fio absorvível versus interrompida com fio permanente no tratamento da diástase do músculo reto abdominal

Introduction: Plication of the rectus abdominis muscle is an important step in remodeling the abdomen in abdominoplasties. It can be performed using several types of threads with interrupted or continuous sutures, according to the surgeon's preferences. Few studies in the literature compared the different plication techniques in abdominoplasties. The present study aimed to compare continuous anchored suture with polydioxanone (PDS) with interrupted nylon suture regarding surgical time, relapse, and costs and discuss the advantages and disadvantages of each method. Methods: A randomized clinical trial in which 30 patients were enrolled for each of the two groups, 15 with continuous suture and 15 with interrupted suture, was conducted. The plication time was compared between the groups using the Student's t-test. Between 10 and 12 months postoperatively, all patients underwent ultrasonography for investigating diastasis recurrence. Results: Continuous suture decreased the plication time by almost 40% when compared to the interrupted suture (p < 0.001), without affecting the esthetic outcome. The PDS used in the continuous suture implied higher costs than those with the nylon threads used in the interrupted suture. No recurrence was found on the postoperative control ultrasonography results. Conclusion: Continuous suture reduced the plication time by almost 40% (p < 0.001) when compared to interrupted suture. Despite being associated with higher costs, PDS seems to be a good alternative to non-absorbable sutures, such as nylon threads, in plications of the rectus abdominis, since it is a more biocompatible material.

Introdução: A plicatura do músculo reto abdominal é um passo importante no remodelamento do abdômen nas abdominoplastias. Ela pode ser realizada com vários tipos de fios e com suturas interrompidas ou contínuas, de acordo com as preferências do cirurgião. Poucos estudos na literatura compararam diferentes técnicas de plicatura nas abdominoplastias. O objetivo do estudo é comparar a sutura contínua ancorada com polidioxanona (PDS) com a sutura interrompida com náilon quanto ao tempo cirúrgico, recidiva, custos e discutir vantagens de desvantagens de cada método. Métodos: Ensaio clínico randomizado no qual 30 pacientes foram arroladas para cada um dos grupos, 15 sutura contínua e 15 sutura interrompida. O tempo de plicatura foi comparado entre os grupos utilizando-se o teste t de Student. Entre 10 a 12 meses de pós-operatório, todas as pacientes foram submetidas à ecografia em busca de recidivas da diástase. Resultados: A sutura contínua diminuiu em quase 40% o tempo de plicatura quando comparada à sutura interrompida (p < 0,001), sem prejuízo no resultado estético. O PDS utilizado na sutura contínua implicou maiores custos que os fios de náilon utilizados na sutura interrompida. Nenhuma recidiva foi encontrada na ecografia de controle no pós-operatório. Conclusão: A sutura contínua quando comparada à sutura interrompida foi capaz de reduzir o tempo de plicatura em quase 40% (p < 0,001). A utilização do PDS, apesar dos maiores custos, parece ser uma boa alternativa às suturas com fios não absorvíveis como o náilon nas plicaturas do músculo reto abdominal, uma vez que se trata de um fio de maior biocompatibilidade.

Evaluating the effectiveness of the lateral intercrural suture to decrease the interdomal distance to improve the definition of the nasal tip in primary rhinoplasty

Introduction: Several surgical techniques emphasizing sutures on the lower lateral cartilage have been studied by surgeons as instruments to improve nasal tip remodeling. It is already known that the domal divergence angle and its definition angle can be modified by lateral intercrural suture (LIS). Techniques for measuring these structures are not yet standardized. Objectives: Assess the efficacy of LIS using polydioxanone 4–0 absorbable thread by interdomal distance and systematize the LIS technique to improve nasal tip definition. Materials and Methods: This prospective study measured and analyzed interdomal distances measured preoperatively and perioperatively compared with 3- and 6-month postoperative measurements. Results: LIS was efficient on reducing interdomal distances. Conclusion: LIS is statistically safe and efficient and has low morbidity when utilized in patients with mild to moderate deformities, because it reduces the domal divergence angle, effectively sustaining the nasal tip...

In vivo Osteogenesis of Cultured Human Periosteal-derived Cells and Polydioxanone/Pluronic F127 Scaffold

Flexor Tenorrhaphy Using Absorbable Suture Materials

BACKGROUND: Nonabsorbable sutures are favorable for repairing flexor tendons. However, absorbable sutures have performed favorably in an animal model. METHODS: Two-strand sutures using the interlocking modified Kessler method with polydioxanone absorbable sutures 4-0 were used to repair completely ruptured flexor tendons in 55 fingers from 41 consecutive patients. The medical records of average 42 follow up weeks were analyzed retrospectively. The data analyzed using the chi-squared test, and Fisher's exact test was used for postoperative complications. The results were compared with those of other studies. RESULTS: Among the index, middle, ring, and little fingers were injured in 9, 17, 16, and 13 fingers, respectively. The injury levels varied from zone 1 to 5. Of the 55 digits in our study, there were 26 (47%) isolated flexor digitorum profundus (FDP) injuries and 29 (53%) combined FDP and with flexor digitorum superficialis injuries. Pulley repair was also conducted. Concomitant injuries of blood vessels and nerves were found in 17 patients (23 fingers); nerve injuries occurred in 5 patients (10 fingers). Two patients had ruptures (3.6%), and one patient had two adhesions (3.6%). Using the original Strickland criteria, all the patients were assessed to be excellent or good. Also, fibrosis and long-term foreign body tissue reactions such as stitch granuloma were less likely occurred in our study. Compared to the Cullen's report that used nonabsorbable sutures, there was no significant difference in the rupture or adhesion rates. CONCLUSIONS: Therefore, this study suggests that appropriate absorbable core sutures can be used safely for flexor tendon repairs.

Biodegradable polydioxanone mesh: Preparation, optimization and in vivo degradation / 第二军医大学学报

Objective: To prepare a novel surgery mesh made of polydioxanone(PDO) and to study its in vivo degradation properties and the related tissue reaction, so as to provide reference for future clinical application. Methods: PDO mesh was plain-woven and was coated with collagen and chitosan, then they were implanted into the dorsal muscle of rabbits for 2, 4, 8, 12, 16, and 24 weeks. Rabbits implanted with pure PDO mesh served as control. The degradation process of implanted materials, tissue-material interface, and the biological influence of the coating on the mesh were observed; tissue reaction was observed and evaluated by histological means and TEM. Results: Implantation of pure PDO mesh resulted in mild inflammation and fibrous tissues infiltrated into the mesh; degradation occurred during the 8th to the 12th week and degraded completely within 24 weeks; there was no denaturalization, necrosis, and abnormal hyperplasia in the surrounding tissues. Collagen coating stimulated a fibroblastic proliferation and was reabsorbed within 4 weeks; and the naked mesh was infiltrated by fibrous tissues. The chitosan coating showed a strong inhibitory effect on the growth of the surrounding connective tissues. Conclusion: The biodegradable polydioxanone mesh has an excellent biocompatibility, a friendly tissue-material interface and a proper degradation rate matching to the tissue regeneration rate. The biological characteristics of the mesh can be modified by different coatings, making it a very promising degradable surgical mesh.

Osteogenic Activity of Cultured Human Periosteal-Derived Cells in a Three Dimensional Polydioxanone/pluronic F127 Scaffold

Tissue-engineered reconstitution of oral mucosa using polydioxanone mesh

The lack of sufficient oral mucosa available for intra-oral reconstruction has been dealt with by the use of skin or oral mucosa grafts harvested from donor sites but grafts requires more than one surgical procedures and could cause donor site morbidity. Many investigators have attempted to increase available soft tissue by tissue engineered skin or oral mucosa replacements for clinical applications. But, reconstructed mucosa by several methods have low physical properties such as rolling and contraction. The aims of this study were to develope an in vitro experimental model that maintains an epithelial-mesenchymal interaction by organotypic raft culture, and to characterize biologic properties of three-dimensionally cultured oral mucosa embedded with Polydioxanone mesh by histological and immunohistochemical analysis. The results were as follows; 1. Oral mucosa reconstructed by three-dimensional organotypic culture revealed similar morphologic characteristics to equvalent normal oral mucosa in the point that they show stratification and differentiation. 2. The expression of cytokeratin 10/13 and involucrin in the cultured tissue showed the same pattern with normal oral mucosa suggesting that organotypic co-culture condition is able to induce cellular differentiation. 3. After insertion of polydioxanone mesh, increased tensile strength were observed. These results suggest that three-dimensional organotypic co-culture of the oral mucosa cell lines with the dermal equvalent consisting type I collagen and fibroblasts reproduce the morphologic and immunohistochemical characteristics similar to those in vivo condition. And increased physical properties by use of polydioxanone mesh will helpful for clinical applications.

Influences of Suture Materials on Corneal Astigmatism After Cataract Surgery

While advancements in microsurgical technique and suture material have led to meticulous wound closure in cataract surgery, excessive postoperative corneal astigmatism may delay visual recovery and compromise the ultimate optical outcome. Greater efforts to prevent and control surgically induced astigmatism have been made recently since the introduction and popularized use of intraocular lenses. Control of astigmatism has been attempted with intraoperative variations in the size, location, and type of incision, the selection of suture material, attention to suture depth and technique, the use of preplaced sutures to facilitate wound closure, and most recently, the application of surgical keratometers. We reviewed follow up records to evaluate and compare the influences on corneal astigmatism after extracapsular cataract extraction(ECCE) with intraocular lens implant in 100 cases of polyglactin 9l0(vicryl) group and 50 cases of polydioxanone (PDS) group, and results were as follows; 1. In planned ECCE group, mean corneal refractive power changes was -0.14D +/- 0.47 in vicryI group and -0.17D +/- 0.78 in PDS group, there was no significant correlation between two. In phacoemulsification(KPE) group, mean corneal refractive power changes was 0.05D +/- 0.49 in vicryl group and 0.27D +/- 0.82 in PDS group. There was no significant correlation between two. 2. In total group, mean corneal refractive power changes was 0.02D +/- 0.48 in vicryl group and 0.08D +/- 0.74 in PDS group. There was no significant correlation between two groups. 3. Mean power of cylindrical lens for correction of astigmatism was -0.76D +/- 0.98 in vicry I group and -0.67D +/- 0.71 in PDS group, there was no significant correlation between two.